To Fight Ebola, Cuba Is Sending Its Biggest Export – Doctors
BY BENNY AVNI 12/15/14 AT 10:00 PM
“They were trying to get us to do the best job we could. We were told
that this is very good income for the country,” said a Cuban doctor
we’ll call Dr. Jose Suarez, describing instructions from his government
as he prepared, five years ago, to leave Cuba for Venezuela. There he
was to join up in his nation’s most prestigious, most successful and
most lucrative enterprise: its physician-export industry.
Along with his wife and children, Suarez now lives in New York, having
defected to the United States in 2009. He asked that his real name and
personal details not be used, fearing that family members back on the
island would suffer retaliation.
Cuba’s export of medical professionals has gained the Communist country
much praise, including most recently from the island’s neighbor and
nemesis, the United States, where top officials have praised Cuba’s
response to the Ebola crisis in West Africa. The Cuban contingent of
medical professionals sent to the epidemic’s hot zone was larger than
any other country’s.
Suarez’s story suggests a nuanced picture behind those international
accolades, in which these doctors, who bravely combat diseases and treat
the poor around the world, are treated as an instrument of the state.
Cuba has trained many more medical professionals per capita than any
other developing or developed country. In 2010 it had 6.7 doctors for
every 1,000 citizens, according to the World Bank. In the United States
in the same year, there were 2.4 doctors for every 1,000 Americans.
Unlike America, however, in Cuba the government alone finances medical
studies, and it then controls the careers of medical professionals.
Suarez said that when he completed his studies, the government noticed
that while he had graduated with honors, he was not interested in
politics and never became a member of the Communist Party.
“You have to work where they tell you,” he said. The young doctor was
sent to Santiago de Cuba, a 12-hour bus ride away from his hometown at
the center of the island. The ride is expensive, and each trip home ate
away at his salary, the Cuban equivalent of $20 a month. A year later,
he was lucky to be assigned to a hospital near his hometown.
Then came the offer to join Cuba’s medical mission in Venezuela. It was
a relatively lucrative offer, and also very hard to refuse. “They
prepare you psychologically,” Suarez said. “They tell you this is
important for the nation, you know, blah blah blah. It all seems very
benign. But if you say no, there will be retaliation. For example, if
you work in a very nice hospital in the city, you will be sent back to
And the conditions in Venezuela were much better than back home. In
Venezuela Suarez was paid $150 a month, while an additional $100 a month
was deposited in his name in a bank back in Cuba. “The government
evaluates your performance, and if you do a good job, you get that extra
money as well,” he said.
That is, of course, only if you return to the island. Unlike many of his
colleagues, whose travel documents were confiscated and kept by the
government, he was considered low risk, so he was allowed to keep his
passport. That helped when he finally defected. Now he practices
internal medicine at a Brooklyn hospital.
No definitive figures have been published by Havana or Caracas about the
financial arrangements between the two countries, which are much more
complex than simply “doctors for cash.” Without Venezuelan oil, the
Cuban economy would have collapsed long ago, and besides physicians,
Cuba sends to Venezuela an unknown number of security officials and
Cuba’s exportation of doctors and other professionals to other Latin
American countries, including Haiti, as well as to far-off places such
as Pakistan and Africa, has become a source of pride for the Caribbean
Last July the general director of Cuba’s Ministry of Foreign Commerce
and Investment, Dagmar González Grau, told Havana’s Popular Assembly
that 64,362 Cuban professionals were sent by the state to serve in 91
countries. Three in four of those professionals are in the health
sector, González Grau said, according to Trabajadores, a state-run
The government, she added, expects those professionals to bring in $8.2
billion in 2014. By those figures, the Cuban government could be earning
as much as $6.15 billion from its exportation of doctors alone.
These proceeds far exceed any other Cuban enterprise, with tourism
lagging well behind in second place. Sales of Cuban staples like cigars,
rum and guayabera shirts are not even close. The sugarcane industry, the
pride of the country during the Cold War (though it was heavily
subsidized by the Soviet Union), is no longer profitable.
When Cuba sent 256 health workers to combat Ebola in West Africa in
October, Havana was universally applauded. The World Health Organization
(WHO) is “extremely grateful for the generosity of the Cuban government
and these health professionals for doing their part to help us contain
the worst Ebola outbreak ever known,” said Margaret Chan, the WHO’s
“Although I did not encounter them personally, I have to commend Cuba,”
the American U.N. ambassador, Samantha Power, said after making a
fact-finding trip to West Africa in late October. She noted that the
Cuban government planned to send 200 physicians to the Ebola-stricken
zone in addition to the initial group. “That is a big gap and a big
need,” Power said.
Maria Werlau, a former vice president at Manhattan Chase Bank and
founder of the Free Society Project, a nonprofit, has researched the
finances of Cuba’s health system and its services-export industry. The
Cuban government, she says, did well for itself by sending doctors to
“It’s brilliant,” Werlau says. “They get money from it. They get
attention. They make the impression that Cuba is a medical power,” and
as a result, the government will get a lot of future contracts to send
medical and other professionals “in servitude conditions” to many other
countries as well.
According to Gregory Hartl, a WHO spokesman, each doctor working in
Western Africa in the fight against Ebola receives from the organization
a per diem grant of $200 to $240 a day, depending on the location of
service. He said that the money is deposited in a local bank in Africa
so that it can be withdrawn by each physician upon presentation of a
WHO-supplied approval slip.
A former health professional who still lives in Cuba and asked to remain
anonymous said that she recently saw a contract that is typically
presented to doctors on their way to the Ebola zone. In it, she said, a
doctor is promised $1,500 a month while working in Africa, and an
additional $1,500 to be deposited in a Cuban bank account, where it can
be withdrawn upon return and evaluation of the work.
It is not clear whether that money comes from the per diem from the
WHO—and is distributed by Cuban officials who collect it on behalf of
the doctors in Africa—or is separate from the WHO money.
Cuban doctors are “sent by their government, so we do not know how that
money is distributed,” said a U.N. official familiar with the
international efforts in Africa, who spoke on condition of anonymity, as
he was not authorized to discuss the matter with the press.
“So what,” said another U.N. official said. “It’s just like U.N.
peacekeepers. Their governments send conscripts, and they get paid for
each soldier. But the troops get very little of the proceeds. Developing
countries use the U.N. as a source of national income.”
Attempts to reach by phone the spokesman for the Cuban mission to the
U.N. were unsuccessful, and he declined to answer an emailed question
about the distribution of WHO funds. But as Cuba’s exportation of
doctors and other professionals grows, there has been some pushback.
Ramona Matos Rodriguez, a Cuban doctor who was sent to Brazil, defected
last summer and sued the Cuban government for damages. She said in a
deposition that the government presented her with a contract promising a
salary of $400 a month, with an additional $600 that would be deposited
in a Cuban bank on the island, to be withdrawn by her later.
When she arrived in Brazil, however, Matos Rodrigues discovered that
Brasilia pays an average of $4,200 a month for each of the 11,000 Cuban
doctors working in Brazil. That arrangement leaves most of the money
Brazil allocates for the doctors in the hands of the Cuban government.
The case became contentious, as the government defended the importation
of thousands of Cuban doctors to serve in remote areas where “Austrian
doctors, for example, wouldn’t work,” said then foreign minister Antonio
Patriota. But a Brazilian union, the National Federation of Physicians,
said in a statement that the arrangement resembles “slave labor,”
serving no one but the Cuban government.
And this month Brazil’s federal prosecutor Luciana Loureiro Oliveira
said that paying Cuban doctors a mere quarter of what the Cuban
government collects for them is “downright illegal” under Brazilian law.
Cuban blogger Orlando Luis Pardo Lazo, who is a student at Brown
University in the United States, says he believes the exportation of
medical staff is having a detrimental effect on Cuba’s own health care
system. Lazo says last year he had to tend to his ailing mother back in
Cuba. “Every time I went to a hospital in the middle of the night, I
found Venezuelan doctors, Bolivian doctors, students from Latin
America,” Lazo said. “Where are the Cuban doctors?”
He added, “I’m not trying to make politics out of this. I would just
like Cuba to help Cubans [and others] in a better way.”
Follow Benny Avni on Twitter @bennyavni.
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